Contents

1. General Surgery....................................................................................................1
A. Wounds and Wound Healing..............................................................................................................................1
Wounds 1; Classification of Wounds 1; Wound Healing 5; Compartment Syndrome 8; Crush Injury 9;Crush
Syndrome 10; Degloving Injuries 10;Keloid11; Hypertrophic Scar 12; Problems with Wound Healing 13

B. Ulcer...................................................................................................................................................................14
Ulcer 14; Granulation Tissue 17; Investigations for an Ulcer 19; Traumatic Ulcer 20; Trophic Ulcer (Pressure Sore/
Decubitus Ulcer) 21;Ulcer due to Chilblains 23;Ulcer due to Frostbite 23; Martorells Ulcer 23;Arterial/Ischaemic
Ulcer 23; Bairnsdale Ulcer 23; Carcinomatous Ulcer (Epithelioma, Squamous Cell Carcinoma) 24;Marjolin's
Ulcer 24; Rodent Ulcer 24; Melanotic Ulcer 24; Diabetic Ulcer 25; Meleneys Ulcer (Postoperative Synergistic
Gangrene) 26; Lupus Vulgaris (LupusWolf ) 26; Tuberculous Ulcer 27; Bazins Disease (Erythrocyanosis Frigida/
Erythema Induratum) 27; Tropical Ulcer 27; Venous Ulcer (Gravitational Ulcer) 28; Syphilitic Ulcer 28; Soft Chancre/
Soft Sore/ Ducreys Ulcer/Chancroid/Bubo 28; Climatic Bubo/Tropical Bubo 29; Clinical Examination of an Ulcer 29

C. Sinus and Fistula...............................................................................................................................................30

Sinus 30;Fistula30; Median Mental Sinus 33;Sequestrum34; Preauricular Sinus 35

D. Infectious Diseases............................................................................................................................................36
Surgical Infection 36;Cellulitis37;Erysipelas38; Erysipeloid Disease 39;Lymphangitis39;Abscess40;
Bacteraemia 45;Septicaemia45;Pyaemia45; Metastatic and Pyaemic Abscess 46; Boil (Furuncle) 46;Hidradenitis Suppurativa 46;Carbuncle47; Potts Puffy Tumour 48; Pyogenic Granuloma (Granuloma Pyogenicum) 49;
Impetigo 49; Scrum Pox 49;Tetanus49; Gas Gangrene 52;Tuberculosis54;Leprosy55; Syphilis (Great Pox)
(French Disease) 56;Actinomycosis56; Madura Foot (Mycetoma Pedis) 57; Rabies (Hydrophobia) 58;Rabies
in Dogs 60;Anthrax61; Nosocomial and Opportunistic Infections 61;Hiv Infection and Aids (Acquired
Immunodeficiency Syndrome) 62; Necrotising Fasciitis 65; Acute Pyomyositis 67; Surgical Site Infection (Ssi) 67

E. Swellings............................................................................................................................................................71
Lipoma 71;Cysts74;Dermoids75; Sebaceous Cyst (Wen, Epidermoid Cyst) 79; Glomus Tumour 82;Papilloma 83;
Warts 84;Fibroma84;Bursae 85; Semimembranosus Bursa 86; Morrant Bakers Cyst 87; Lymph Cyst (Lymphatic
Cyst) 88;Lymphangioma88; Calcinosis Cutis 89;Neuroma89;Neurofibroma90; Neurilemmoma (Schwannoma) 92;Ganglion93;Chordoma93;Epignathus93

f. Electrolyte and Nutrition..................................................................................................................................95

Normal Physiology 95; Water Loss (Volume Loss) 95; Water Excess (Ecf Volume Excess) 95;Ecf Loss 96;
Ecf Excess 96;Hyponatraemia96;Hypernatraemia97;Hypokalaemia97;Hyperkalaemia98;Hypermagnesaemia 98;Hypomagnesaemia98; Acid-Base Balance 98; Metabolic Alkalosis 99; Respiratory Alkalosis 99;Metabolic
Acidosis 99; Respiratory Acidosis 100; Anion Gap 100; Fluid Therapy 100;Nutrition101;Gastrostomy103;Jejunostomy 104; Total Parenteral Nutrition (Tpn) 104; Refeeding Syndrome 106; Obesity and Morbid Obesity 106;Different
Surgeries 107

G. Shock................................................................................................................................................................111
Shock 111; Stages of Shock 112; Effects of Shock 112; Clinical Features of Shock 115; Investigations in
Shock 115; Central Venous Pressure (Cvp) 116; Pulmonary Capillary Wedge Pressure (Pcwp) 116;Systemic
Inflammatory Response Syndrome (Sirs) 117; Multiple Organ Dysfunction Syndrome (Mods) 117;Oxygen
Therapy 118; Topical O2-Therapy 118; Cardiac Arrest 118

H. Haemorrhage and Blood Transfusion............................................................................................................121

Haemorrhage 121; Blood Transfusion 124; Blood Substitutes 126; Massive Blood Transfusion 126;Autologous
Blood Transfusion 127; Artificial Blood 127;Erythropoietin127;Tourniquets127; Disseminated Intravascular
Coagulation (Dic) 128; Mechanism of Blood Coagulation (Haemostasis) 129

I. Burns................................................................................................................................................................130
Burns 130; Management of Burns 134;Eschar136; Contracture in Burn Wound 137; Electrical Burns 139;
Inhalation Injury 141; Chemical Burns 141

xvi

J. Trauma.............................................................................................................................................................143
Triage 143; Spinal Injury 145; Neck Injuries 146; Bullet Injuries 146; Blast Injuries 147; Penetrating Injuries 148; Abdominal Trauma 148; Blunt Trauma of Abdomen 150; Duodenal Injury 152; Pancreatic Injury 153;Small
Bowel Injury 153; Colonic Injury 154; Liver Injury 154; Splenic Injury 154; Renal Injury 154;Urinary Bladder
Injury 154; Abdominal Compartment Syndrome 154; Seatbelt Injuries 155

K. Hand and Foot.................................................................................................................................................156

Hand 156; Hand Infections 157; Acute Paronychia 160; Chronic Paronychia 161; Apical Subungual Infection 161; Terminal Pulp Space Infection (Felon) 161; Infection of Web Spaces 162; Deep Palmar Space
Infection 162; Space of Parona Infection 164; Acute Suppurative Tenosynovitis 164; Compound Palmar
Ganglion 165;Orf166; Milkers Nodes 166; Hand Injuries 166; Dupuytrens Contracture 168; Volkmanns Ischaemic
Contracture 168;Syndactyly169; Mallet Finger (Base Ball Finger) 170; Heberdens Nodes 170; Spina Ventosa 170;
Foot 170;Callosity170;Corn171; Plantar Fasciitis (Policemans Heel) 172; Ingrowing Toe Nail 172;Onychogryphosis 172;Onychomycosis172; Athletes Foot 172; Hallux Valgus 173

SRB's Manual of Surgery

L. Arterial Diseases..............................................................................................................................................174
Surgical Anatomy of Thoracic Outlet 174; Arteries of Upper Limb 175; Arteries of Lower Limb 175;Arterial
Diseases 175; Intermittent Claudication 175; Rest Pain 176; Limb Ischaemia 176; Pregangrene 177;Gangrene
177; Different Levels of Arterial Obstruction 178; Other Features of Poor Circulation 178; Investigations for Arterial
Diseases 179; Diseases of the Arteries 182;Atherosclerosis182; Thromboangiitis Obliterans (Tao) Syn. Buergers
Disease 184; Takayasus Pulseless Arteritis 188; Raynauds Phenomenon 188; Temporal Arteritis 190;Treatment
of Arterial Diseases 190; Subclavian Steal Syndrome 196; Acute Arterial Occlusion 196; Traumatic Acute Arterial
Occlusion 197;Embolism197; Reperfusion Injury 199; Saddle Embolus 200;Embolectomy200; Fat Embolism 201; Air Embolism 201; Therapeutic Embolisation 201; Caissons Disease or Decompression Disease 202;Aneurysm 202; Mycotic Aneurysm 203; Abdominal Aneurysm 203; Abdominal Aortic Aneurysm 204;Peripheral
Aneurysm 208; Carotid Artery Aneurysm (Extracranial) 209; Dissecting Aneurysm 209;Erythromelalgia/
Erythralgia 210; Livedo Reticularis 210; Polyarteritis Nodosa 210; Scleroderma/Systemic Sclerosis 211;Acrocyanosis (Crurum Puellarum Frigidum) 211;Gangrene211; Diabetic Foot and Diabetic Gangrene 213;Trophic
Ulcer 214; Bedsores (Decubitus Ulcer) (Pressure Sores) 214;Frostbite215;Ainhum215;Endovascular
Surgeries 215;Upper Limb Ischaemia 216; Arterial Substitutes 220

M. Vascular Lesions and Hamartoma.................................................................................................................221

Vascular Anomalies 221;Haemangioma221; Vascular Malformations 225; Cirsoid Aneurysm 225;Arteriovenous
Fistula (Avf) 225; Campbell de Morgan Spots 229; Parry-Romberg Disease 229;Hamartomata229

N. Venous Diseases..............................................................................................................................................230
Anatomy of Veins of Lower Limb 230; Physiology of Venous Blood Flow in Lower Limb 231; Deep Vein
Thrombosis (Dvt) 231; Varicose Veins 235; Venous Ulcer (Gravitational Ulcer) 249; Compression Therapy for
Varicose Veins 251;Thrombophlebitis251; Klippel-Trenauny Syndrome 252;Anticoagulants252;Heparin252;
Low Molecular Weight Heparin (Lmwh) 252; Oral Anticoagulants 253;Warfarin253; Direct Thrombin
Inhibitors 253; Antiplatelet Drugs 253; Pulmonary Embolism 254

O. Lymphatics.......................................................................................................................................................255
Surgical Anatomy 255;Lymphangiography 257; Isotope Lymphoscintigraphy 257;Lymphoedema 257;Lymphomas264; Hodgkins Lymphoma (Hl) 265; Non-Hodgkins Lymphoma (Nhl) 269; Malt Lymphoma
(Maltoma) 270; Burkitts Lymphoma (Malignant Lymphoma of Africa) 270; Cutaneous T Cell Lymphoma 270;Chylous
Ascites 271;Chylothorax271;Chyluria271;Sarcoidosis272

P. Peripheral Nerves............................................................................................................................................273
Peripheral Nerve Injuries 273;Tinels Sign 275; Brachial Plexus Injuries 275;Causalgia275; Median Nerve
Injury 276; Carpal Tunnel Syndrome 276;Ulnar Nerve Injury 278; Claw Hand 278; Radial Nerve Injury 279;
Common Peroneal Nerve Injury 280; Foot Drop 280; Medial Popliteal Nerve Injury 281; Axillary Nerve Injury 281;
Long Thoracic Nerve Injury (Nerve of Bell) 281; Meralgia Paraesthetica 281

Q. Neoplasm.........................................................................................................................................................282
Definition 282;Dysplasia283;Carcinoma in Situ 284; Aetiologic Factors 284; Spread of Malignant
Tumours 284; Grading of Tumour 285; Staging of the Tumour 285; Paraneoplastic Syndromes 286;Investigations
for Neoplasm 286; Management Strategy for Cancers 291

R. Skin Tumours...................................................................................................................................................293
Anatomy 293; Classification of Skin Tumours 293; Skin Adnexal Tumours 294; Dermatofibroma (Sclerosing Angioma
or Subepithelial Benign Nodular Fibrosis) 296; Dermatofibrosarcoma Protuberans 296; Keratoacanthoma (Molluscum
Sebaceum) 296; Rhinophyma (Potato Nose) (Bottle Nose) 297; Seborrhoeic Keratosis (Seborrhoeic Wart, Basal
Cell Papilloma) 298; Squamous Cell Carcinoma(Epithelioma) (Khangri Cancer) (Chimney Cancer) 299;Marjolins
Ulcer 302; Basal Cell Carcinoma (Rodent Ulcer) 303; Turban Tumour 306;Naevi306;Melanoma308

S. Sarcomas..........................................................................................................................................................318
Sarcoma 318;Liposarcoma325;Fibrosarcoma326; Malignant Fibrous Histiocytoma (Mfh) 326;Leiomyo
sarcoma 327;Rhabdomyosarcoma327;Chondrosarcoma327;Haemangiosarcoma328;Lymphangiosarcoma 328; Synovial Sarcoma 328; Malignant Peripheral Nerve Sheath Tumour (Mpnst) 328; Kaposis Sarcoma 328

xvii

T. Amputations....................................................................................................................................................330
Amputation 330; Complications of Amputations 337;Prosthesis339

U. Reconstruction................................................................................................................................................340
Graft 340; Skin Grafts 340;Flaps 344; Tendon 351; Tendon Repair 351; Tendon Transfer 352; Tendon Graft 352

V. Transplantation...............................................................................................................................................353
Preoperative Evaluation 353; Organ Procurement 354; Renal Transplantation 354;Immunosuppressive
Agents 355; Liver Transplantation 357; Bone Marrow Transplantation 359; Pancreatic Transplantation 359;Small
Bowel Transplantation 359;Dialysis359; Cimino Fistula (Cimino-Brescia) 360

W. Stings and Bites...............................................................................................................................................362

Snake Bite 362; Spider Bite 362; Bee Bite 363; Mammalian Bite 363

X. Pain...................................................................................................................................................................364
Gate Control Theory 364

2. Faciomaxillary Diseases................................................................................... 367

Diseases of the Palate 367; Orthopantomogram (Opg) 367; Cleft Lip and Cleft Palate 368; Maxillofacial Injuries 372;Primary
Care (Early Care) in Maxillofacial Injuries 374; Fracture Middle Third Area 375; Zygomatic Complex Fracture 376;Fracture
of the Mandible 378; Dislocation of the Mandible 380; Preauricular Sinus 380; Jaw Tumours 381; Epulis (GreekMeans
Upon Gum) 382; Ameloblastoma (Adamantinoma, Eves Disease, Multilocular Cystic Disease of the Jaw) 383; Dentigerous Cyst
(Follicular Odontome) 384; Dental Cyst (Radicular Cyst, Periapical Cyst) 385; Osteomyelitis of Jaw 385;Alveolar
Abscess (Dental Abscess) 386; Fibrous Dysplasia of Bone/Jaw 386; Cherubism (CherubAngelic Being) 388

3. Oral Cavity........................................................................................................ 389

4. Salivary Glands................................................................................................. 431

Anatomy 431; Saliva 434;Sialography434; Salivary Calculus and Sialadenitis 435;Sialosis437;Sialectasis437;Recurrent Childhood Parotitis 438; Parotid Abscess (Suppurative Parotitis) 438; Parotid Fistula 438; Sjgrens Syndrome 439;
Mikulicz Disease 440; Salivary Neoplasms 440; Pleomorphic Adenoma (Mixed Salivary Tumour) 441;Adenolymphoma (Warthins Tumour, Papillary Cystadenolymphomatosum) 444; Oncocytoma (Oxyphil Adenoma) 445; Basal Cell
Adenoma 445; Mucoepidermoid Tumour 445; Adenoid Cystic Carcinoma (10% of Salivary Tumours) 446; Acinic Cell
Tumour 446; Malignant Mixed Tumour (Mmt) 446; Adenocarcinoma of Salivary Glands 446; Squamous Cell Carcinoma
of Salivary Glands 447; Submandibular Salivary Gland Tumours 447; Management of Malignant Salivary Tumours 447;
Minor Salivary Gland Tumours 450; Parotid Lymphoma 451;Parotidectomy451; Freys Syndrome (Auriculotemporal
Syndrome, Gustatory Sweating); (Lucie FreyPolish Surgeon1932) 452; Facial Nerve Injury (Lower Motor Nerve Lesion,
Surgically Related) 453

5. Neck................................................................................................................... 455
Anatomy of Lymphatics of Head and Neck 455; Thoracic Outlet Syndrome (Tos) 456; Cervical Rib 457;Branchial
Cyst 459; Branchial Fistula 460; Pharyngeal Pouch 462;Laryngocele463; Cystic Hygroma (Cavernous Lymphangioma) 464; Ludwigs Angina 465; Parapharyngeal Abscess 466; Retropharyngeal Abscess 466;Subhyoid
Bursitis 467; Carotid Body Tumour (Potato Tumour, Chemodectoma, Nonchromaffin Paraganglioma) 468;Torticollis
(Wry Neck) 469; Sternomastoid Tumour 469; Tuberculous Lymphadenitis 470; Cold Abscess 474; Secondaries in Neck
Lymph Nodes 475; Chemotherapy for Head and Neck Cancers 482

6. Thyroid.............................................................................................................. 484
Development 484;Anatomy484; Physiology 486; Congenital Anomalies 486; Thyroid Function Tests 489;Fnac of
Thyroid 489; Classification of Goitre 490; Diffuse Hyperplastic Goitre 491; Multinodular Goitre (Mng) 491; Discrete Thyroid
Nodule 494; Solitary Thyroid Nodule 494; Retrosternal Goitre 497; Thyrotoxicosis and Hyperthyroidism 499;Radioactive

Contents

Ranula 389; Sublingual Dermoids 390;Stomatitis390; Cancrum Oris (Noma) 391; Syphilitic Lesions of Oral Cavity 392;
Leukoplakia 392;Erythroplakia393; Oral Submucosal Fibrosis 393; Premalignant Conditions of Oral Cavity 394;
Oral and Upper Aerodigestive Cancers 394;Cheek396; Carcinoma Cheek/Buccal Mucosa 396;Lip408; Neoplasm of
Lip 410; Carcinoma Lip 410;Tongue414; Tongue Ulcers 415; Benign Tumours of Tongue 416; Tongue Fissure 416;
Glossitis 416; Tongue Tie 417; Carcinoma Tongue 417; Carcinoma of Posterior One-Third/Base of the Tongue 422;
Nasopharyngeal Carcinoma 423; Maxillary Tumours 424; Malignant Tumours of Tonsil 426; Carcinoma Hard
Palate 427; Laryngeal Tumours 427; Malignant Tumours of Larynx 427;Trismus430

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Iodine 508; Thyroid Neoplasms 509; Differentiated Thyroid Carcinoma (Dtc) 509; Papillary Carcinoma of Thyroid (Pct) 510;
Follicular Carcinoma of Thyroid (Fct) 512; Anaplastic Carcinoma of Thyroid 515; Medullary Carcinoma of Thyroid
(Mct) 518; Malignant Lymphoma 519; Hashimotos Thyroiditis (Struma Lymphomatosa) 519; De-Quervains Subacute
Granulomatous Thyroiditis 519; Riedels Thyroiditis (0.5% Common) 520; Thyroid Incidentaloma 520;
Thyroidectomy 521; Emil Theodor Kocher 526; Kochers Test 526;Hypothyroidism526; Recurrent Laryngeal Nerve
Palsy 527

7. Parathyroids and Adrenals.............................................................................. 531

Anatomy 531;Calcium531; Hyperparathyroidism (Hpt) 532;Parathyroidectomy534;Men Syndrome (Mea
Syndrome) 536;Apudomas536;Hypoparathyroidism537;Tetany537;Adrenals538; Adrenal Cortical
Tumours 538; Adrenocortical Carcinoma 539; Cushings Syndrome 539; Conns Syndrome 540; Virilising Syndrome
or Adrenogenital Syndrome 540;Neuroblastoma540;Pheochromocytoma542

8. Breast................................................................................................................ 544
Anatomy 544;Mammography547; Aberration of Normal Development and Involution (Andi) of the Breast 548;Fibroadenoma 548; Fibrocystadenosis (Fibrocystic Disease of the Breast/Mammary Dysplasia/Cyclical Mastalgia with
Nodularity) 551; Sclerosing Adenosis 552; Phyllodes Tumour (Cystosarcoma Phyllodes/Serocystic Disease of
Brodie) 552; Mastalgia (Pain in the Breast) 553; Traumatic Fat Necrosis 554;Galactocele554;Mastitis555;Antibioma 558; Duct Ectasia 558; Mondors Disease 558; Tuberculosis of the Breast 559; Breast Cysts 559;Galactorrhoea 560; Gynaecomastia (GreekWomen Breast) 560; Duct Papilloma 562; Zuska-Atkins Disease 563;Mammary
Fistula of Atkins 563; Carcinoma Breast 563; Management of Early Carcinoma Breast 586; Advanced Carcinoma
Breast 590; Prognostic Factors in Carcinoma Breast 592; Prophylactic Mastectomy 593; Carcinoma of Male
Breast 593; Breast Reconstruction 594; Breast Implants 596; Nipple Retraction 597

SRB's Manual of Surgery

9. Peritoneum....................................................................................................... 599
Anatomy 599;Physiology599; Acute Peritonitis 600; Primary Peritonitis 600; Secondary Peritonitis 600;Tertiary
Peritonitis 600; Spontaneous Bacterial Peritonitis (Sbp) 605; Sclerosing Peritonitis 606; Biliary Peritonitis 606;Postoperative Peritonitis 606; Other Forms of Peritonitis 607; Pelvic Abscess 607; Subphrenic Spaces and Subphrenic
Abscess 608; Mesenteric Cysts 611; Mesenteric Panniculitis 612; Acute Mesenteric Lymphadenitis 612;Mesenteric Malignancy 612; Mesenteric Trauma 613; Peritoneal Malignancy 613; Omental Cyst 614;Omental
Torsion 614; Omental Tumour 614

10. Abdominal Tuberculosis.................................................................................. 615

Abdominal Tuberculosis 615; Ileocaecal Tuberculosis 616; Ileal Tuberculosis 621; Peritoneal Tuberculosis 621;Tuberculous Mesenteric Lymphadenitis 624; Ano-Recto-Sigmoidal Tuberculosis 626; Tuberculosis of the Omentum 626

11. Liver................................................................................................................... 627

Surgical Anatomy of Liver 627; Liver Function Tests (Lft) 628; Alfa-Feto Protein (Afp) 628; Liver Biopsy 629;Liver
Injury 629; Infections of Liver 631; Liver Tumours 642; Liver Cysts 649; Portal Hypertension 651;Oesophageal
Varices 654; Portal Hypertensive Gastropathy 661;Ascites661; Ascites in Portal Hypertension 663;Budd-Chiaris
Syndrome 664; Hepatic Failure 664; Hepatic Encephalopathy 665; Hepatorenal Syndrome 665; Hepatic Resection 665; Portal Biliopathy 668

12 Gallbladder....................................................................................................... 669
Surgical Anatomy 669; Oral Cholecystogram (Ocg; Graham-Cole Test) 670; Iv Cholangiogram 671;Endoscopic
Retrograde Cholangio-pancreatography (Ercp) 671; Percutaneous Transhepatic Cholangiography (Ptc) 672;
Magnetic Resonance Cholangio-pancreatog raphy (Mrcp) 673; Radioisotope Scan Study 673;Peroperative
Cholangiogram 673; Postoperative T-Tube Cholangiogram 673; Congenital Anomalies of Gallbladder 673;
Choledochal Cysts 675; Carolis Disease 677; Biliary Atresia 677;Gallstones679; Acute Cholecystitis 684;
Acute Acalculous Cholecystitis 686; Empyema Gallbladder 687; Mucocele of the Gallbladder 688;Chronic
Cholecystitis 688;Cholecystoses689; Dissolution Therapy for Gallstones 690;Choledocholithiasis690;Sump
Syndrome 694; Courvoisiers Law 694; Surgical Jaundice (Obstructive Jaundice) 695;Cbd Strictures (Biliary
Strictures) 697; Sclerosing Cholangitis 699; Gallbladder Polyp 699; Benign Biliary Papilloma 699;Carcinoma
Gallbladder 699; Cholangiocarcinoma (Bile Duct Carcinoma) 702; Klatskin Tumour 702; Biliary Fistulas 703;
Gallstone Ileus 703;Hemobilia704; White Bile 705;Cholecystectomy705; Laparoscopic Cholecystectomy 706;Single
Incision Laparoscopic Surgery (Sils) in Cholecystectomy 708; Bile Duct Injuries 708;Post-cholecystectomy
Syndrome 709; Biliary Dyskinesia 710

13. Spleen................................................................................................................ 711

Surgical Anatomy 711; Functions of the Spleen 711;Splenunculi712; Splenic Injury (Rupture Spleen) 712;Splenomegaly 716; Hereditary Spherocytosis 716; Immune Haemolytic Anaemia 717; Thalassaemia (Mediterranean Anaemia/
Cooleys Anaemia/Erythroblastic Target Cell Anaemia) 718; Sickle Cell Disease 718; Idiopathic (Immune) Thrombocyto-

penic Purpura (Itp) 718; Thrombotic Thrombocytopenic Purpura (Ttp) 720;Splenectomy720; Overwhelming Postsplenectomy Infection (Opsi) 722; Splenic Artery Aneurysm 722; Splenic Abscess 723;Hypersplenism723;Splenic
Cyst 724

xix

14. Pancreas............................................................................................................ 725

Anatomy 725; Serum Amylase 726; Magnetic Resonance Cholangio-pancreatography (Mrcp) 727;Pancreatitis 727; Acute Pancreatitis 727; Complications of Acute Pancreatitis 732; Pseudocyst of Pancreas 734; Chronic Pancreatitis 738; Pancreatic Tumours 746; Exocrine Pancreatic Tumours 746; Carcinoma Pancreas 747; Endocrine Pancreatic
Tumours 755;Insulinomas756;Gastrinomas757;Glucagonomas758; Zollinger-Ellison Syndrome 758;Cystic
Fibrosis 758; Annular Pancreas 759; Ectopic (Accessory) Pancreatic Tissue 759; Pancreatic Divisum 759;Pancreatic
Calculus 760; Pancreatic Ascites 760; Pancreatic Fistulae 760; Pancreatic Abscess 761; Pancreatic Necrosis 761;Pancreatic Trauma 762; Cystic Lesions of Pancreas 763; Exocrine Pancreatic Disease 763

15. Retroperitoneal Space..................................................................................... 764

Anatomy of Retroperitoneum 764; Retroperitoneal Fibrosis 764; Retroperitoneal Swellings 765;Retroperitoneal
Tumours 766; Psoas Abscess 769

16. Differential Diagnosis of Mass Abdomen....................................................... 771

Mass in the Right Hypochondrium 773; Mass in the Epigastrium 775; Mass in the Left Hypochondrium 778; Mass in
the Lumbar Region 778; Mass in the Umbilical Region 780; Mass in the Right Iliac Fossa 780; Mass in the Left Iliac
Fossa 781; Mass in the Hypogastrium 781

17. Abdominal Wall and Umbilicus....................................................................... 784

Diseases of the Umbilicus 784;Omphalitis784;Umbilical Granuloma 786; Anomalies of Vitellointestinal Duct 786;Umbilical Sinus 787;Umbilical Adenoma (Raspberry Tumour) 787;Umbilical Fistula 788; Patent Urachus 788; Burst Abdomen
(Abdominal Dehiscence) (Acute Wound Failure) 788; Abdominal Wall Tumours 791; Desmoid Tumour 791;Exomphalos
(Omphalocele) 792; Gastroschisis (Belly Cleft) 793; Rectus Sheath Haematoma 794; Abdominal Wall Abscess 794;
Meleneys Progressive Synergistic Bacterial Gangrene of Abdominal Wall 795; Diverication of Recti (Diastasis Recti) 796

Hernia 797;Aetiology797; Parts of Hernia 798; Classification of Hernia 799; Inguinal Hernia 800; Surgical Anatomy
of Inguinal Canal 800; Classification of Inguinal Hernia (Earlier) 802; Newer Classification of Hernia 803;Indirect
(Oblique) Inguinal Hernia 803; Direct Hernia 811; Malgaigne Bulging 817; Incarcerated Hernia 817;Strangulated
Hernia 817; Sliding Hernia (Hernia-En-Glissade) 820; Pantaloon Hernia (Double Hernia, Saddle Hernia, Romberg
Hernia) 821; Infantile Hernia 821; Femoral Hernia 822; Ventral Hernia 824; Incisional Hernia 825;Umbilical
Hernia 829; Paraumbilical Hernia (Supra- and Infraumbilical Hernia) 831; Epigastric Hernia (Fatty Hernia of Linea
Alba) 831; Spigelian Hernia 833; Obturator Hernia 834; Richters Hernia 834; Lumbar Hernia 835;Phantom
Hernia 835; Sciatic Hernia 836; Complications of Hernia Surgery 836; Parastomal Hernia 836; Different Types of
Hernia 837

19. Oesophagus...................................................................................................... 838

Anatomy 838; Lower Oesophageal Sphincter (Los) 839;Dysphagia840; Contrast Study of Oesophagus 841;Oesophagoscopy 842; Oesophageal Endosonography 842; Gastro-oesophageal Reflux Disease (Gord/Gerd) 842;Hiatus
Hernia 847; Rolling Hernia (Paraoesophageal Hernia) 848; Reflux Oesophagitis 848; Barretts Oesophagus (Norman
Barrett, British, 1950) 849; Barretts Ulcer 849; Oesophageal Motility Disorders 849; Achalasia Cardia (Cardiospasm) 850; Plummer-Vinson Syndrome (Paterson-Kelly Syndrome) 853; Corrosive Stricture of Oesophagus 854;Schatzkis
Rings 856; Boerhaaves Syndrome 856; Mallory-Weiss Syndrome 856; Tracheo-oesophageal Fistula 857;Oesophageal
Diverticulum 857; Carcinoma Oesophagus 858; Benign Tumours of the Oesophagus 866; Oesophageal Perforation 867; Foreign Body Oesophagus 867

20. Stomach............................................................................................................ 869

Anatomy 869; Blood Supply of Stomach 870; Nerve Supply of Stomach 870;Histology870; Lymphatic Drainage of
Stomach 871;Duodenum871; Gastric Physiology 871; Gastric Function Tests 872;Gastrin873; Barium Meal
Study 873;Gastroscopy874; Helicobacter Pylori 875; Congenital Hypertrophic Pyloric Stenosis 876;Gastritis877;
Acute Peptic Ulcer (Duodenal or Gastric Ulcer) 878; Gastric Ulcer 879; Duodenal Ulcer 882; Pyloric Stenosis Due
to Chronic Duodenal Ulcer 885; Perforated Peptic Ulcer 887; Bleeding Peptic Ulcer 891;Haematemesis893;
Complications of Gastric Surgery 894; Trichobezoar (Rapunzel Syndrome) 898; Chronic Duodenal Ileus (Wilkies
Syndrome) 898; Durbans Syndrome 899; Acute Gastric Dilatation 900; Gastric Volvulus 900; Gastric Polyp 901;Menetriers
Disease 901; Duodenal Diverticula 902; Carcinoma Stomach 902; Gastric Lymphoma 915; Gastric Sarcomas 916;Gastrointestinal Stromal Tumours (Gist) 917;Pyloroplasty918;Gastrostomy918;Gastrectomy919;Gastrojejunostomy
(Gj) 920; Retrograde Jejunogastric Intussusception 920;Vagotomy920

Contents

18. Hernia................................................................................................................ 797

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21. Small Intestine.................................................................................................. 922

Anatomy 922; Meckels Diverticulum 923; Regional Enteritis (Crohns Disease) 925; Surgical Complications of
Typhoid 928; Surgical Complications of Roundworm (Ascaris Lumbricoides) 929; Pneumatosis Cystoides Intestinalis 931; Mesenteric Vessel Ischaemia 931; Necrotising Enterocolitis 934; Small Bowel Tumours 935; Benign Tumours
of Small Bowel 936; Malignant Tumours of Small Bowel 937; Carcinoid Tumour 939; Short Bowel Syndrome (Short
Gut Syndrome) 941; Massive Bowel Resection 941; Small Bowel Enema (Enteroclysis) 942; Capsule Endoscopy 942;
Small Bowel Enteroscopy 943; Enteric/Gastrointestinal Fistula 943

22. Large Intestine.................................................................................................. 948

Anatomy 948; Hirschsprungs Disease (Congenital Megacolon) 949; Diverticular Disease of the Colon 951;Ulcerative Colitis 954; Ischaemic Colitis 959; Pseudomembranous Colitis 960; Surgical Complications of Intestinal Amoebiasis 960; Tumours of Colon 961; Benign Tumours/Polyp of the Colon 961; Juvenile Polyps 961;Metaplastic/Hyperplastic
Polyp 961; Peutz-Jeghers Polyp 962; Adenoma of Colon 962; Familial Adenomatous Polyp (Fap) 963;Gardners
Syndrome 964; Carcinoma Colon 964; Angiodysplasia of Colon 974; Ogilvies Syndrome 974;Colostomy975;Stoma
Care 977; Stoma Appliances 978; Faecal Fistula 979; Preparation of Large Bowel for Surgery 980;Surgical
Pouches 980; Barium Enema 981

23. Intestinal Obstruction...................................................................................... 983

Intestinal Obstruction: Types 983; Dynamic Obstruction 984; Duodenal Atresia 989; Small Intestine Atresia (Intestinal
Atresia) 990;Malrotation991; Meconium Ileus 992; Intussusception (Iss) 994;Volvulus997; Sigmoid Volvulus
(Volvulus of Pelvic Colon) 997; Paralytic Ileus (Adynamic Intestinal Obstruction) 1000; Adhesions and Bands 1000;Internal
Hernias 1003

SRB's Manual of Surgery

24. Appendix......................................................................................................... 1005

Surgical Anatomy 1005; Duplication of Appendix (Wallbridge Classification) 1005; Acute Appendicitis 1006;Incidental
Appendicectomy 1013; Appendicular Mass (Periappendicular Phlegmon) 1014; Appendicular Abscess 1015;Faecal
Fistula After Appendicectomy 1016; Mucocele of Appendix 1016; Neoplasms of the Appendix 1017;Laparoscopic
Appendicectomy 1017

25. Rectum and Anal Canal.................................................................................. 1020

Anatomy 1020;Per-rectal Examination (Digital Examination of the Rectum) 1021; Proctoscopy (Kellys) 1022;Sigmoidoscopy 1022;Colonoscopy1022; Carcinoma Rectum 1023; Solitar y Ulcer Syndrome 1029;Rectal
Prolapse 1030; Anorectal Malformations (Arm) 1034; Pilonidal Sinus/Disease (Jeep Bottom; Drivers Bottom) 1036;Piles/
Haemorrhoids 1038; Anal Fissure (Fissure-in-ano) 1046; Anorectal Abscess 1049;Fistula-in-ano1051;Anorectal
Strictures 1056; Condyloma Acuminata 1057; Anal Intraepithelial Neoplasia (Ain) 1057; Malignant Tumours of Anal
Area 1057; Anal Margin Tumours 1058; Sacrococcygeal Teratoma 1058; Anal Incontinence 1059; Descending Perineal
Syndrome 1059;Proctitis1060; Proctalgia Fugax 1060; Hidradenitis Suppurativa of Anal Region 1060;Pruritus
Ani 1060; Gastrointestinal Haemorrhage (Gi Bleed) 1061

26. Urology........................................................................................................... 1065

A. Kidney........................................................................................................................................................... 1065
Anatomy of Kidney and Ureter 1065;KidneyAnatomy1065;UreterAnatomy1066; Plain X-rayKidney,
Ureter and Bladder (Kub) 1066; Intravenous Urogram (Ivu) 1067; Retrograde Pyelography (Rgp) 1068;Renal
Angiogram 1069; Micturating Cystourethrography (Mcu) 1069; Ascending Urethrogram 1069; Isotope Renography 1070;Cystoscopy1071;Catheters1071; Foleys Catheter (Fredrick Eugene Basil FoleyAmerican Urologist) 1072; Malecots Catheter 1073; Red Rubber Catheter 1073;Nephrostomy1074; Suprapubic Cystostomy
(Spc) 1074;Haematuria1075; Horseshoe Kidney 1076; Cystic Diseases of the Kidney 1076; Polycystic Kidney
Disease (Pckd) 1077; Duplication of Renal Pelvis and Ureter 1078; Retrocaval Ureter 1079;Ureterocele1080;
Injuries to Kidney 1080; Renal Tuberculosis 1081; Hydronephrosis (Hn) 1084;Pyonephrosis1088; Carbuncle of
Kidney (Renal Carbuncle) 1088; Perinephric Abscess 1089; Renal Calculus 1089;Ureteric Calculi 1094;Staghorn
Calculus 1097; Benign Tumours of Kidney 1098; Wilms Tumour (Nephroblastoma) 1099; Renal Cell Carcinoma
(Rcc) 1100; Approaches to Kidney (Surgical) 1104

B. Urinary Bladder............................................................................................................................................ 1105

Anatomy 1105; Ectopia Vesicae (Extrophy of the Bladder) 1106;Urachal Anomalies 1106;Vesical
Calculus 1106;Cystitis1110; Recurrent Cystitis 1110; Interstitial Cystitis (Hunners Ulcer, Elusive Ulcer) 1110;Schistosoma Haematobium (Endemic Haematuria, Urinary Bilharziasis) (Swimmers Itch) 1111; Thimble or Systolic
Bladder 1111; Bladder Tumours 1112; Transitional Cell Carcinoma (Tcc) 1112;Ureterosigmoidostomy1115;Rupture
Bladder (Bladder Injury) 1115; Residual Urine 1116;Malakoplakia1116; Neurogenic Bladder 1117;Vesicoureteric
Reflux 1117; Bladder Diverticula 1118;Urinary Diversion 1119;Urinary Fistulas 1120

C. Prostate......................................................................................................................................................... 1121
Anatomy 1121; Acid Phosphatase 1121; Prostate Specific Antigen (Psa) 1121; Benign Prostatic Hyperplasia
(Bph) 1122;Prostatitis1125; Bladder Outlet Obstruction (Boo) 1125; Carcinoma Prostate 1126

xxi

D. Urethra.......................................................................................................................................................... 1129
Anatomy 1129;Urethral Injury 1129; Rupture of Membranous Urethra and/or Prostatic Urethra (Posterior
Urethra) 1129; Rupture of Bulbous Urethra (Anterior Urethra) 1130; Stricture Urethra 1131;Hypospadias 1132;Epispadias1133; Posterior Urethral Valve 1133;Urethral Calculi 1134;Urethritis1135;Extravasation
of Urine 1135; Retention of Urine 1136

E. Penis.............................................................................................................................................................. 1138
Phimosis 1138;Paraphimosis1139;Circumcision1140;Balanoposthitis1141; Chordee (Cordee) 1141;Priapism 1141; Peyronies Disease (Induratio-Penis Plastica) 1141; Rams Horn Penis 1142; Carcinoma Penis 1142;BuschkeLowensteins Tumour 1147

F. Scrotum......................................................................................................................................................... 1148
Anatomy 1148; Fourniers Gangrene 1148;Hydrocele1149; Primary Vaginal Hydrocele 1150; Secondary Hydrocele 1151;Haematocele1154;Pyocele1155; Cyst of Epididymis 1155;Spermatocele1156;Varicocele1157

G. Testis.............................................................................................................................................................. 1160
Anatomy 1160;Undescended Testis 1161; Ectopic Testis 1163; Retractile Testis 1164; Torsion of the
Testis 1164; Testicular Tumours 1165; Paratesticular Tumours 1170;Orchitis1170;Epididymitis1171

27. Neurosurgery.................................................................................................. 1172

Head Injuries 1172; Extradural Haematoma 1177; Subdural Haematoma 1178; Subarachnoid Haemorrhage
(Sah) 1179; Depressed Skull Fracture 1180;Hydrocephalus1181; Intracranial Abscess 1182; Intracranial Aneurysms 1182; Intracranial Tumours 1183; Pituitary Tumours 1186;Craniopharyngiomas1187; Spinal Dysraphism 1187;Meningocele1188; Spina Bifida 1188; Intervertebral Disc Prolapse (Ivdp) 1189; Tuberculosis of Spine
(Caries Spine) 1190; Spinal Tumours 1193

Chest Injuries 1194; Fracture Ribs 1195; Flail Chest and Stove in Chest 1196;Pneumothorax1197; Tension Pneumothorax 1197;Haemothorax1198; Pleural Tap 1198;Bronchoscopy1199; Empyema Thoracis 1199;Empyema
Necessitans 1200; Lung Abscess 1201; Intercostal Tube Drainage 1202; Shock Lung (Stiff Lung) 1203;Pulmonary Embolism (Pe) 1203; Surgical Emphysema 1204; Lung Cysts 1204; Mediastinal Tumours 1205;Thymomas
1207; Pancoast Tumours (Superior Sulcus Tumour) 1208; Chest Wall Tumours 1208;Pericarditis1209;Acute
Pericarditis 1209; Chronic Constrictive Pericarditis (Picks Disease) 1210; Pericardial Tap 1210;Cardiac
Tamponade 1210; Diaphragmatic Hernia 1211; Pulmonary Complications during Postoperative Period 1213;Surgical
Management of Pulmonary Tuberculosis 1214; Video Assisted Thoracoscopic Surgery (Vats) 1214

Cardiac Surgery.................................................................................................................................................. 1215

Anatomy 1215;Preoperative Assessment and Preparation of the Cardiac Patient 1216;Cardiopulmonary
Bypass 1217; Congenital Heart Diseases 1217; Patent Ductus Arteriosus (Pda)10% 1217; Coarctation of
Aorta5% 1218; Atrial Septal Defect (Asd)7% 1218; Ventricular Septal Defect (Vsd)15% 1219;Pulmonary
Stenosis 1219; Transposition of Great Vessels 1219; Tetralogy of Fallot 1220; Acquired Heart Disease 1220;Mitral
Regurgitation 1221; Aortic Stenosis 1221; Aortic Regurgitation 1221; Valve Replacement Surgery 1222;Ischaemic
Heart Disease (Ihd) 1222;Cardiac Pacemakers 1223; Postoperative Care 1223

29. Adjuvant Therapy........................................................................................... 1224

Radiotherapy 1224;Chemotherapy1227; Cell Cycle 1227; Antimalignancy Drugs 1227; Hormone Therapy in
Cancer 1227;Immunosuppression1229;Immunotherapy1229;Hybridoma1229; Gene Therapy 1230

30. Anaesthesia.................................................................................................... 1231

Preoperative Assessment 1231; General Anaesthesia 1232; Anaesthetic Agents 1232;Oxygen1232;
Muscle Relaxants 1232; Reversal Agents 1232; Instruments in Anaesthesia 1232; Complications of General Anaesthesia 1234; Postoperative Care 1234; Monitoring the Postoperative Patient 1234; Regional Anaesthesia 1235;Topical
Anaesthesia 1235; Infiltration Block 1235; Field Block 1235; Nerve Block 1235; Intravenous Regional Anaesthesia (Biers
Block) 1235; Spinal Anaesthesia 1235; Saddle Block 1236; Epidural Anaesthesia 1236; Caudal Anaesthesia 1237

31. Advanced Imaging Methods......................................................................... 1238

Ultrasound 1238;Doppler1240;Ct Scan 1240; Magnetic Resonance Imaging (Mri) 1242; Radionuclide Imaging 1243;
Positron-Emission Tomography (Pet Scan) 1243

Contents

28. Thorax............................................................................................................. 1194

xxii

32. Operative Surgery.......................................................................................... 1244

A. Asepsis and Sterilisation............................................................................................................................. 1244
Sterilisation 1244;Disinfection1244;Antisepsis1244;Asepsis1244; Different Methods of Disinfection/
Sterilisation 1244

B. Instruments.................................................................................................................................................. 1247
Cheatles Forceps 1247; Sponge Holding Forceps (Rampleys) 1247; Mayos Towel Clip 1247; Artery Forceps
(Haemostat) 1247; Right Angle Forceps 1248; Kochers Forceps 1248; AllisTissue Holding Forceps 1248;Babcocks
Forceps 1248; Lanes Tissue Holding Forceps 1249; Morant-Bakers Appendix Holding Forceps 1249;Volkmanns
Retractor 1249; Langenbecks Retractor 1249; Czernys Retractor (Hernia Retractor) 1249; Morris Retractor 1249;
Deavers Retractor 1249; Doyens Retractor 1250; Self-retaining Retractor 1250; Single Hook Retractor 1250;Plain
Non-toothed Dissecting Forceps 1250; Toothed Dissecting Forceps 1250; Surgical Needles 1250;Needle
Holder 1251; Jolls Thyroid Retractor 1251; Moynihans Occlusion Clamp 1251; Payrs Crushing Clamp
(Gastric) 1251; Desjardins Choledocholithotomy Forceps 1251; Bakes Dilator 1251; Sinus Forceps (Listers) 1252;
Scissors 1252; Volkmanns Scoop 1252;Tracheostomy Tube 1252;Drains1252; Foleys Catheter 1254;Malecots
Catheter 1254; Simple Red Rubber Catheter 1254; Listers Urethral Dilator 1254; Ryles Tube 1254; Infant Feeding
Tube 1255; Kehrs T Tube 1255;Proctoscope1255; Flatus Tube 1255

C. Suture Materials........................................................................................................................................... 1256

Classification I 1256;Classification Ii 1257;Classification Iii 1257;Classification Iv 1257; Classification V 1257

D. Diathermy (Electrocautery)........................................................................................................................1258
Types 1258

SRB's Manual of Surgery

E. Operative Procedure.................................................................................................................................... 1259

Abdominal Incisions 1259;Vasectomy1260;Circumcision1260;Hydrocele1261; Inguinal Hernia 1261;
Appendicectomy 1262;Thyroidectomy1262;Tracheostomy1263;Cryosurgery1264; Lasers in Surgery
(Light Amplification Stimulated Emission of Radiation) 1265; Staplers in Surgery 1265; Nasojejunal Tube
Feeding 1266; Gossypiboma (GossypiumCotton Based in Latin) 1266

F. Laparoscopic Surgery.................................................................................................................................. 1267

Advantages of Laparoscopic Surgery 1267; Laparoscopic Cholecystectomy 1268; Laparoscopic Appendicectomy 1269; Advanced Laparoscopic Surgeries 1269; Diagnostic Laparoscopy 1270;Retroperitoneoscopy 1270; Natural Orifice Transluminal Endoscopic Surgery (Notes) 1270

G. Dressings and Bandages............................................................................................................................. 1272

Dressings 1272;Bandages1272

H. Day Care Surgery.......................................................................................................................................... 1274

Day Care Surgery 1274; Surgical Audit 1275; Surgeon and Law 1276

33. Miscellaneous................................................................................................. 1277

A. Fascinating Signs in Surgery....................................................................................................................... 1277
B. Triads in Surgery.......................................................................................................................................... 1287
C. Misnomers in Surgery.................................................................................................................................. 1288
D. Triangles in Surgery..................................................................................................................................... 1289
E. Drugs at a Glance......................................................................................................................................... 1291
Antibacterials 1291;Sulfonamides1291;Quinolones1291;Penicillin1292; Ampicillin/Amoxycillin/Tala
mpicillin/Pivampicillin 1292;Methicillin1292;Cloxacillin/Dicloxacillin/Flucloxacillin1292;Carbenicillin/
Ticarcillin 1292;Piperacillin/Azocillin/Mezlocillin1292; Clavulanic Acid 1292;Sulbactum1292;Tazobactum 1292;Carbapenem/Imipenem/Meropenem1292;Lincomycin/Clindamycin1292;Vancomycin/Teicoplanin 1293;Cephalosporins1293;Macrolides1293;Aminoglycosides1293;Tetracyclines1294;Chloramphenicol/Thiamphenicol 1294; Drugs For Tuberculosis 1294; Antiamoebic Drugs 1295;Important
Antihelminthics 1295;Anticoagulants1296; Other Drugs 1296

Appendix................................................................................................................................................................................. 1299
Further Reading.................................................................................................................................................................... 1303
Index........................................................................................................................................................................................ 1305